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Predictors of a weak antibody response to COVID-19 mRNA vaccine in systemic lupus erythematosus

  • Observational Research
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Abstract

Objectives

To characterize the antibody response to COVID-19 mRNA vaccination in patients with Systemic Lupus Erythematosus (SLE) and identify predictors of poor response.

Methods

SLE patients who are followed at the Beth Israel Deaconess Medical Center Lupus Cohort (BID-LC) were enrolled. SARS-CoV-2 IgG Spike antibody was measured in patients who received two doses of either the BNT162b2 (Pfizer-BioNTech) or the mRNA-1273 (Moderna) COVID-19 vaccine (n = 62). We defined non-responders as patients with an IgG Spike antibody titer less than two-fold (< 2) the index value of the test and responders as patients with antibody levels greater or equal to two-fold (≥ 2). A web-based survey was used to collect information regarding immunosuppressive medication use and SLE flares after vaccination.

Results

In our cohort of lupus patients, 76% were vaccine responders. The use of two or more immunosuppressive drugs was associated with being a non-responder (Odds Ratio 5.26; 95% CI 1.23–22.34, p = 0.02). Both Belimumab use and higher Prednisone dose were associated with vaccine non-response (p = 0.04 and p = 0.04). The non-responder group had higher mean levels of serum IL-18 than the responder group (p = 0.04) as well as lower C3 levels (p = 0.01). Lupus flares and breakthrough infections were uncommon post-vaccination.

Conclusions

Immunosuppressive medications have a negative impact on vaccine humoral response in SLE individuals. We observed a trend towards vaccine no-response in BNT162b2 recipients and a relationship between IL-18 and impaired antibody response that merits further investigation.

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Author notes

  1. Christine Parsons and Jose Rubio contributed equally to this work.

Authors and Affiliations

  1. Division of Rheumatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, MA, CLS-93602215, Boston, USA

    Christine Parsons, Jose Rubio, Afroditi Boulougoura, Suzanne Krishfield & Vasileios Kyttaris

  2. Harvard Medical School, Boston, MA, USA

    Christine Parsons, Jose Rubio, Afroditi Boulougoura, Suzanne Krishfield & Vasileios Kyttaris

  3. Division of Rheumatology and Clinical Immunology, University of Alabama, Birmingham, AL, USA

    Jose Rubio

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Contributions

VC Kyttaris contributed to the design of the work, analysis, interpretation of the data, revising the manuscript, approval of the final version, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JR contributed to the design of the work, analysis, acquisition, and interpretation of the data, drafting and revising the manuscript, approval of the final version, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CP contributed to the acquisition and interpretation of the data, drafting and revising of the manuscript, approval of the final version, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AB contributed to the conception of the work, acquisition of the data, revising the manuscript, approval of the final version, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SK contributed to the acquisition of data, revising manuscript, approval of the final version, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All data for this manuscript is available on request.

Corresponding author

Correspondence to Vasileios Kyttaris.

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Parsons, C., Rubio, J., Boulougoura, A. et al. Predictors of a weak antibody response to COVID-19 mRNA vaccine in systemic lupus erythematosus. Rheumatol Int 43, 1621–1627 (2023). https://doi.org/10.1007/s00296-023-05347-w

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